Strategic Provider Engagement Manager (Hybrid/Remote)

Centene Management Company LLC; Texas; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid/office work

Job summary

Centene is seeking a Provider Relations Manager to strengthen partnerships between the health plan and contracted provider networks in the United States. You will lead provider relations, drive performance improvements, and coordinate with internal teams to resolve claims and policy issues.

The role requires a Bachelor’s degree and 2+ years in managed care or related operations, with travel up to four days per week.

Qualifications

• Bachelor’s degree in a related field or equivalent experience.
• Two years of managed care or medical group experience.
• Experience with provider relations, quality improvement, claims, contracting utilization management, or clinical operations.

Responsibilities

• Serve as primary contact for providers and liaison between providers and the health plan.
• Triages provider issues for resolution with internal partners.
• Receive and respond to external provider-related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Initiate data entry of provider-related demographic information changes.
• Educate providers regarding policies and procedures related to referrals and claims submission, website usage, EDI solicitation and related topics.
• Conduct provider orientations and ongoing provider education, including updating orientation materials.
• Manage network performance for the assigned territory using a consultative/account management approach.
• Evaluate provider performance and develop strategic plans to improve performance.
• Drive provider performance improvement in risk, quality, and cost/utilization areas.
• Complete special projects as assigned.
• Travel locally 4 days a week.
• Perform other duties as assigned.
• Comply with all policies and standards.

Skills

Provider relations

Quality improvement

HEDIS/Quality measures

Contracting utilization management

Project management

Education

Bachelor’s degree in related field

Two years of managed care experience

Job description

Centene is seeking a Provider Relations Manager to strengthen partnerships between the health plan and contracted provider networks in the United States. You will lead provider relations, drive performance improvements, and coordinate with internal teams to resolve claims and policy issues.

The role requires a Bachelor’s degree and 2+ years in managed care or related operations, with travel up to four days per week.